Provider Demographics
NPI:1487686242
Name:BISBAL, OSWALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:OSWALDO
Middle Name:
Last Name:BISBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BATES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7637
Mailing Address - Country:US
Mailing Address - Phone:207-784-5784
Mailing Address - Fax:207-784-1477
Practice Address - Street 1:77 BATES ST STE 202
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7637
Practice Address - Country:US
Practice Address - Phone:207-784-5784
Practice Address - Fax:207-784-1477
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238351207RG0100X
ME017819207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433425499Medicaid
ME000788201Medicare PIN